Unsayable statements

In this post I want to finish the story of  the phone call from the previous post. My doctor’s receptionist phoned me asking to make a ‘routine appointment’. I saw a doctor – the conversation reinforced my conviction that my doctors and I live in different universes.For the first time in 25 years, a doctor had someone phone me with a request to make a routine appointment. The whole situation was a contradiction. How do you square the extraordinary phone call with the ‘routine’ appointment? Despite my enquiries whether the receptionist could offer some insight what it was all about, she refused. She also refused to make an ‘extraordinary’ appointment, well, until I appealed to her humanity. I saw a doctor (a locum). The conversation moved me right into the Monty Python universe.

Why did I receive this extraordinary phone call? Well, I don’t know. The doctor went through the blood tests with me only to tell me that there was, again, nothing wrong with me. As I am way beyond tolerating these kind of statements, I said that just because there was nothing in the tests that had been ordered didn’t mean there was nothing wrong with me. To my surprise, the medic agreed me (probably because he was a locum).

Anyway, my jaw dropped. And before I continue, let’s go linguistics – it’s again about communicative rights (well, and power).  Let’s consider the following question: “Why couldn’t the receptionist tell me that the results showed nothing?” The answer is easy, of course, because she is a receptionist. The message simply doesn’t belong to the lowly receptionist, as it conveys ‘medical information’. And so, it’s better that I worry (and I do tend to worry), possibly wait a few weeks for the ‘routine appointment’, as long as the receptionist does not play doctor and pass this crucially complex message that my blood tests showed nothing and the appointment was to discuss what now. If she could say it, it’s almost like you take something away from the doctor in this 0-sum game. If the receptionist passes on the message, it diminishes the doctor, it seems. The message becomes unsayable (much like in Foucault).

But as I was looking for my jaw, I actually asked the question. The doctor’s face showed utter bewilderment – he really didn’t expect such a question. But to his credit he did apologise to me (probably because he was a locum).

And here we come to the absurdity of the situation.  The receptionist engages in a communication which is way out of the ordinary, yet she is not allowed to tell me why. She is not allowed to tell me anything, I think, lest she should encroach on the privileged medical communication. As the doctor protects their communication rights, I pay the price with my distress. No, I do not think for one second, it was a decision on the part of the doctor, just complete lack of reflection underpinned by the power structure of medicine.

But why did I worry, you might ask. After all, the receptionist did tell me it was a routine appointment, which I refused to believe. Do consider the context, though – medium is the message here. I received a phone call, out of hours, to make an appointment. How do I not read this as important? And yes, this is my point: the situation would be diffused immediately, if the receptionist had been asked to tell me that the appointment was to discuss the future action. Simple? Clearly not.

So, what of the conversation with the doctor? In a way, it was funny. As I told him the whole story again, I could see the blank expression – he had no idea and he really didn’t know how to say it. Once again, it was  so obvious that telling a patient ‘I don’t know.’ is almost beyond the doctor’s capacity. Another thing that undermines them, it seems. The simplest of statements is unsayable, as they talk about ‘nonspecific results’, until you say: ‘You have no idea, do you?’. The discomfort is palpable, I mean, you can cut it into cubes.

I actually started wondering whether medical students should have seminar in telling the patient they don’t know. I am being serious here. I so wish, I could hear:

I actually don’t know what’s wrong with you, I am going to try a number of options, but at the moment I don’t know.

It’s much better than: why are you looking for an illness? Isn’t it just?

There are two reflections I want to end with. First, I’ve never been ill for longer than a couple of weeks. Now, it’s been 5 months. This has changed my outlook on things and in particular on the nature of doctor-patient communication. I see the power games between me and the medic in much sharper focus. And I have so much more symbolic capital than your average patient. Spare a thought on them.

Second, I never thought part of this blog would be devoted the ‘discourse analysis’ of my own experience. But I have decided to write about this experience, because before rejecting it as ‘individual’, my experience should be seen as situated. It has roots in communicative and other practices, as well as in the training my doctors receive. It comes from something and as I tell you my stories, I hope we can identify that ‘something’ more readily.


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